Bioethics and the Dogma of “Brain Death”

Two cases involving “brain death&rdquo; have received considerable public attention, including commentary by several well-known bioethicists. In commenting on these cases the bioethicists have stated, in no uncertain terms, that an individual correctly diagnosed as “brain dead&rdquo; is dead, pure and simple.&nbsp; Contrary to appearances of being alive, in reality the “brain dead&rdquo; individual is a corpse.&nbsp; These statements are misleading because they have ignored the long-standing controversy and debate in the professional literature over the determination of death:&nbsp; specifically, whether individuals diagnosed as “brain dead&rdquo; should be considered dead and, if so, why they are dead.&nbsp;

One of the recent cases involved Jahi McMath, a young patient who suffered massive brain injury following an operation; her parents have insisted that she is alive and that mechanical ventilation and other life-sustaining treatment should be maintained.&nbsp; In the other case a hospital, appealing to state law, continued life-sustaining treatment for a Marlise Munoz, a pregnant “brain dead&rdquo; woman, over the objection of her family.That treatment ended earlier this week after a Texas judge ruled in favor of the family.

While brain death is legally recognized as death in all 50 states, we are not alone in arguing that the “brain dead&rdquo; remain alive in view of the biological conception of death established within medicine:&nbsp; the irreversible cessation of the functioning of the organism as a whole. [1] The diagnostic criteria for “brain death,&rdquo; when correctly applied, demonstrate definitively the presence of an irreversible coma without the capacity to breathe spontaneously. But does that mean that the “brain dead&rdquo; are known to be dead?&nbsp; Incontrovertible evidence has been developed over the past two decades that those individuals who meet diagnostic criteria for “brain death&rdquo; can continue to maintain, with the aid of mechanical ventilation, a wide array of biological functions of the organism as a whole, [2] including respiration, circulation, digestion, temperature control, wound healing, and fighting infections.&nbsp; Indeed, relevant to one of the two recent cases in the news, “brain dead&rdquo; pregnant women with intensive care support have been able to gestate viable fetuses over a period of a few months.[3]

The upshot, we have argued, is that the “brain dead&rdquo; remain alive, although without any chance of recovering consciousness or breathing spontaneously.&nbsp; It is possible that we are mistaken.&nbsp; Perhaps a cogent rationale can be developed for why the “brain dead&rdquo; are dead consistent with a biological conception of death; perhaps a consciousness-based standard for determining death can be defended, despite the theoretical and practical difficulties that such a view must face.&nbsp; What is unmistakable, however, is that there is no consensus in the bioethics literature that “brain death&rdquo; constitutes death.&nbsp; Indeed, this is signified unequivocally by the title (and content) of a 2008 report by The President&rsquo;s Council on Bioethics, “Controversies in the Determination of Death.&rdquo;

How, then, should we evaluate recent bioethics commentary in the new media endorsing the dogma that the “brain dead&rdquo; are known to be dead?&nbsp; Here we are interested in provoking reflection on this question as a general matter regarding bioethics scholarship and public communication, rather than quoting and criticizing the commentary of specific named bioethicists.&nbsp;

Journalists frequently interview bioethicists to help the public understand complex and perplexing ethical issues posed by the use of medical technology.&nbsp; They are consulted because of their expertise as bioethics scholars.&nbsp; Likewise, bioethicists rely on their expertise in posting blogs aimed at contributing to public understanding and discussion of these issues.&nbsp; To do this competently is challenging, especially in the context of journalists seeking pithy “sound bites.&rdquo;&nbsp; Yet some guidelines certainly should apply.&nbsp; Public statements of bioethicists should reflect, or at least not misrepresent, the professional literature on the topic under discussion.&nbsp; And bioethics commentators should endeavor not to over-simplify the complexity of the relevant facts and the state of ethical thinking about the facts.&nbsp; Embracing the dogma that “brain death&rdquo; constitutes death, put forward as the uncontested truth, flies in the face of a minimal standard for bioethics commentary.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.